| NPI | 1750636981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101258459) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NV 17274) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NV 17274) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2021-02-20 |